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Patho II > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

What are the two types of tumors?

A

Benign and Malignant

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2
Q

What are the characteristics of Benign tumors?

A 
Innocent behavior
Localized lesions
Don't spread
Patient typically survives
Surgically removable
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3
Q

What do benign tumors have that malignant tumors don’t have?

A

a pressed fibrous connective tissue capsule made of stromal cells

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4
Q

What are the characteristics of Malignant tumors?

A

“cancer”
aggressive behavior
Metastasis

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5
Q

Fibroma is…

A

Benign tumor of adult fibrous tissue

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6
Q

Myxoma is…

A

benign tumor of embryonic fibrous tissue

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7
Q

Lipoma is…

A

Benign tumor of fat

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8
Q

Chondroma is…

A

Benign tumor of cartilage

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9
Q

Osteoma is…

A

Benign tumor of bone

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10
Q

Fibrosarcoma is…

A

Malignant tumor of adult fibrous tissue

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11
Q

Myxosarcoma is…

A

Malignant tumor of embryonic fibrous tissue

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12
Q

Liposarcoma is…

A

Malignant tumor of fat

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13
Q

Chondrosarcoma is…

A

Malignant tumor of Cartilage

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14
Q

Osteosarcoma is…

A

Malignant tumor of bone

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15
Q

Hemangioma is…

A

Benign tumor of blood vessels

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16
Q

Lymphangioma is…

A

Benign tumor of lymph vessels

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17
Q

Hemangiosarcoma/angiosarcoma is…

A

Malignant tumor of blood vessels

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18
Q

Lymphangiosarcoma is…

A

Malignant tumor of lymph vessels

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19
Q

Leiomyoma is…

A

Benign tumor of smooth muscle

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20
Q

Rhabdomyoma is…

A

Benign tumor of striated muscle

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21
Q

Leiomyosarcoma is..

A

Malignant tumor of smooth muscle

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22
Q

Rhabdomyosarcoma is…

A

Malignant tumor of striated muscle

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23
Q

Papilloma, Seborrheic Keratosis, and some skin adnexal tumors are…

A

benign tumors of stratified squamous epithelial tissue

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24
Q

Adenoma is…

A

Benign tumor of Glandular Epithelium

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25
Q

Hepatic Adenoma, Renal Tubular adenoma, and Bile duct adenoma are…

A

Benign tumor of Liver, kidney and Bile duct

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26
Q

Squamous cell carcinoma, epidermoid carcinoma and some skin adnexal tumors are…

A

Malignant tumors of stratified squamous epithelial tissue

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27
Q

Adenocarcinoma is..

A

Malignant tumor of Glandular Epithelium

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28
Q

Hepatoma, hepatocellular carcinoma, renal cell carcinoma, hypernephroma cholangiocarcinoma are…

A

Malignant tumors of Liver, Kidney, and bile duct

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29
Q

Transitional cell papilloma is…

A

Benign tumor of transitional epithelium

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30
Q

Transitional cell carcinoma is…

A

Malignant tumor of transitional epithelium

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31
Q

Seminoma, embryonal cell carcinoma are..

A

Malignant tumors of testis

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32
Q

Glioma grades 1-3 anaplastic, glioblastoma grade 4 are…

A

Malignant tumors of glial cells

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33
Q

Ganglionneuroma is…

A

Benign tumor of nerve cells

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34
Q

Neuroblastoma and Medulloblastoma are…

A

malignant tumors of nerve cells

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35
Q

Meningioma is…

A

Benign tumor of meninges

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36
Q

What are the two basic components of all tumors?

A

Neoplastic cells

Supporting Stroma

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37
Q

What are neoplastic cells?

A

constitute the tumor parenchyma

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38
Q

What do neoplastic cells determine?

A

classification of tumors and their biologic behavior

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39
Q

What is the supporting stroma?

A

non-neoplastic connective tissue, blood vessels, and adaptive/innate immunity cells

Supports growth and proliferation of tumor cells

Tumor Microenvironment

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40
Q

What does the supporting stroma determine?

A

how the tumor will grow and proliferate

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41
Q

What does the tumor microenvironment consist of?

A

Hematopoietic Cells
Cells with Mesenchymal Origin
Non cellular components

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42
Q

What are hematopoietic cells?

A

cells arising in bone marrow

T and B cells
Natural Killer Cells
macrophages
neutrophils

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43
Q

What are cells with mesenchymal origin?

A 
Fibroblasts
Myofibroblasts
Mesenchymal stem cells
Adipocytes
Endothelial Cells
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44
Q

What are the noncellular components of the tumor microenvironment?

A

ECM:
proteins
glycoproteins
proteoglycans

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45
Q

What is the significance of the tumor microenvironment?

A

protects cancer cells

Has important influence on the malignancy outcome and treatment responses

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46
Q

What is differentiation?

A

How closely tumor cells histologically and functionally resemble their normal cell counterpart

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47
Q

What is anaplasia?

A

lack of differentiation of tumor cells; MALIGNANCY’s HALLMARK

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48
Q

What is metaplasia?

A

replacement of one cell type with another cell type; normal physiologic response to chronic inflammation

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49
Q

What is dysplasia?

A

CHAOS; loss of cellular uniformity and architectural organization

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50
Q

What is carcinoma in situ?

A

Marked dysplastic changes involving the ENTIRE thickness of the epithelium

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51
Q

What is invasive carcinoma?

A

the basement membrane isn’t intact anymore so the cells can escape and metastasize

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52
Q

What doesn’t have local invasion?

A

Benign tumors

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53
Q

What is metastasis?

A

invasion of lymphatics, blood vessels, or body cavities by tumor, followed by transport and growth of secondary tumor cell masses dislodged from the primary tumor

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54
Q

What are pathways of tumor spread?

A

Seeding of body cavities and surfaces
Lymphatic spread
Hematogenous Spread
Iatrogenic spread

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55
Q

What is seeding of body cavities and surfaces?

A

disperson into peritoneal, pleural, pericardial, subarachnoid, and joint spaces

Will spread into places that there isn’t a barrier

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56
Q

What is lymphatic spread?

A

Transport of tumor cells to regional nodes and throughout the body

Mostly associated with carcinomas

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57
Q

What is hematogenous spread?

A

typical of sarcoma and some carcinomas; metastasis follows the venous flow pattern

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58
Q

What are the most common sites of hematogenous spread?

A

Lung and liver

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59
Q

What is iatrogenic spread?

A

when they do a biopsy and the surgical instrument is a tool for seeding the cancer

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60
Q

What is tumor metastatic tropism?

A

a tumor’s tendency to metastasize to specific organs

indicates the cancer cells ability to adopt to and colonize in the microenvironment of secondary tissues

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61
Q

Which cancers metastasize to the brain?

A

Lung tumors
breast tumors
Melanoma

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62
Q

What cancers metastasize to the liver?

A

pancreatic cancer

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63
Q

What cancers metastasize to the bone marrow?

A

prostate cancer

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64
Q

What are the mechanisms of tropism?

A

Some tumor cells have adhesion molecules with expression of ligands in a specific organ

Some tumor cells have chemokine receptors in particular organ

Microenvironment of an organ might not be suitable

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65
Q

What are two places that are rarely sites of metastasize?

A

Skeletal muscle and spleen

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66
Q

What may also determine where tumors metastasize to?

A

circulation layouts like primary colon cancer following the portal vein drainage from the colon to the liver and causing liver cancer

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67
Q

What are environmental risk factors of cancer?

A 
infectious agents
smoking
alcohol consumption
diet
obesity
Reproductive history
carcinogens
68
Q

Why is age an important risk factor for cancer?

A

because as we age we accumulate somatic mutations and have a decline in immune response

69
Q

What are three acquired predisposing factors in cancer?

A

chronic inflammation
precursor lesions
Immunodeficiency states

70
Q

Why does chronic inflammation increase the risk of cancer?

A

because there is an increased flow of immune response cells to the site which can increase the chance of mutation in that area; ROS are also produced and they damage DNA

71
Q

Where do precursor lesions occur and why do they increase the risk of getting cancer?

A

they occur in settings of chronic inflammation and change the cells

72
Q

What determines whether precursor lesions will be become malignant or not?

A

there genetic expression pattern

73
Q

What type of T cell deficiency also increased the risk of cancers?

A

CD8+

74
Q

What are the 10 Hallmarks/Characteristics of Cancer?

A 
Sustaining Proliferative Signaling
Avoiding Immune Destruction
Enabling replicative immortality
tumor promoting inflammation
Activating invasion and metastasis
Genomic instability
Inducing angiogenesis
Resisting cell death
Deregulating cellular energetics
75
Q

What are the normal steps of cell proliferation?

A

1) Growth factor binding to cell surface receptor
2) Activation of signal transduction proteins
3) Initiating DNA transcription

76
Q

What are oncogenes?

A

genes that promote autonomous cell growth; cancer cells have these

77
Q

What are protooncogenes?

A

Genes that inhibit autonomous cell growth

78
Q

What does tyrosine kinase-mediated signal transduction do in normal cells?

A

causes cellular growth, apoptosis, and cell migration

79
Q

In cancer cells, what happens to tyrosine kinase pathway?

A

The pathway is hyperreactive due to mutations

80
Q

What causes activation of oncogenes to malignant transformation?

A

Mutations or Overexpression of MYC oncogenes

81
Q

How is MYC oncogenes hyperactivated in human tumors?

A

by translocation between Chromosome 8 and 14

82
Q

What cancers do MYC oncogenes overexpression cause?

A

Burkitts lymphoma
B cell lymphoma
Lung cancers

83
Q

What is Burkitt Lymphoma?

A

an aggressive type of B cell lymphoma most often in children and young adults

84
Q

What do tumor suppressor genes do normally?

A

slow down cell divisions, repair DNA mistakes, and activate apoptosis

85
Q

What happens to tumor suppresor genes in cancer?

A

they are inactivated

86
Q

What is Loss of heterozygosity?

A

mutation of both alleles of tumor suppressor genes are needed for carcinogenesis

87
Q

What are examples of LOH?

A

RB and P53

88
Q

What does RB gene mutation cause?

A

persistent cell cycling which contributes to the pathogenesis of childhood tumor Retinoblastoma

89
Q

What does the TP53 protein normally do?

A

prevents the growth of genetically defective cells

90
Q

How does the TP53 protein prevent the growth of genetically defective cells?

A

Senses DNA damage
Arrests the cell cycle
If DNA can be repaired, the cell undergoes S phase
If DNA cannot be repaired, TP 53 induces apoptosis

91
Q

What percentage of cancers have a mutated p53 gene?

A

50%

92
Q

What is antitumor immunity?

A

t cell recognition of tumor antigen leading to t cell activation

93
Q

How does the tumor evade immune response?

A

Failure to produce tumor antigen causing lack of T cell recognition of tumor

Mutations in MHC genes or genes needed for antigen processing causing lack of T cell Recognition of tumor

Production of immunosuppressive proteins or expressin of inhibotry cell surface proteins causing inhibition of T cell activation

94
Q

What type of immunity does tumor cells evade?

A

cell mediated Immunity:

CD8+ T cells
Natural Killer Cells
Macrophages

95
Q

How do tumor cells enable replicative immortality?

A

By keeping telomerase active so that the tumor cells telomeres never get so short that they would undergo apoptosis

96
Q

What is the metastatic cascade?

A

Invasion of ECM

Vascular disemmination and homing of tumor cells

97
Q

What are the steps in invasion of ECM?

A

1) detachment and loosening of intracellular junctions
2) ECM degredation
3) Migration

98
Q

How is the ECM degraded in the invasion of ECM?

A

by proteases creating a passage

99
Q

What are the 4 theories on how metastasis occurs?

A

1) Clonal evolution model
2) metastasis signature
3) metastatic variants
4) microenvironment

100
Q

What is the clonal evolution model?

A

rare variant clones in the primary tumor cause it to metastasize

101
Q

What does the microenvironment do to cause metastasis?

A

influences angiogenesis, local invasiveness, and resistance to immune defense of the host

102
Q

What is genomic instability?

A

a process of gene alterations which cause DNA repairs to not be fixed and unstable DNA; can increase the risk of cancer

103
Q

What genes are mutated in breast cancer?

A

BRCA1 and 2

104
Q

What gene is mutated in ovarian, prostate, and stomach cancers?

A

BRCA 2

105
Q

What is angiogenesis?

A

new blood vessel growth

106
Q

What is angiogenesis’ dual effect on tumor growth?

A

1) stimulates tumor growth through endothelial cell production of growth factors
2) influences metastatic potential

107
Q

How does angiogenesis increase for tumor cells?

A

the tumor cells sense hypoxia and this causes upregulation of VEGF which causes angiogenesis

108
Q

What cells are primed for apoptosis?

A

Normal cells that have a predominance of PROAPOPTOTIC proteins

109
Q

What cells are unprimed for apoptosis?

A

Cancer cells that have a predominance of ANTIAPOPTOTIC proteins

110
Q

What pathway do cancer cells use to get their energy?

A

anaerobic respiration because they don’t have a lot of oxygen and they can move faster because this pathway only creates two molecules of ATP

111
Q

What are the two steps involved in chemical carcinogenesis?

A

1) Initiation

2) Promotion

112
Q

What is initiation of chemical carcinogenesis?

A

induction of IRREVERSIBLE mutations in the genome

Can be direct acting agents or indirect acting agents

113
Q

What is promotion of chemical carcinogenesis?

A

can induce tumors in previously initiated cell by stimulating cellular proliferation

short lived, REVERSIBLE, and non-tumorigenic by themselves

114
Q

What are direct acting agents of initiation?

A

They don’t need metabolic activation; need to be cautious

115
Q

What are indirect acting agents of initiation?

A

They do need metabolic activation; ex. polycyclic hydrocarbons

116
Q

What are two types of radiation carcinogenesis?

A

UV rays of sunlight

Ionizing Radiation

117
Q

What are some forms of ionizing radiation?

A

Xrays, gamma rays

118
Q

What are the most toxic, mutagenic, and carcinogenic UV light induced DNA photoproducts?

A

Cyclobutane Pyrimidine Dimers (CPDs)

6-4) pyrimidine-pyrimidone photoproducts (6-4PPs

119
Q

What causes the most prominent damage to our macromolecules?

A

UVB rays

120
Q

How does UVB rays damage our macromolecules?

A

damages DNA by creating pyrimidine dimers that create a kink in the DNA structure

121
Q

What does UVA rays create?

A

ROS

122
Q

Which type of UV rays is there no protection for?

A

UVA rays

123
Q

How does ionizing radiation cause cancer?

A

1) damages the nucleotides or DNA sugar molecules
2) causes strand breaks in DNA
3) indirect DNA damage by increasing ROS in cell

124
Q

Both benign and malignant tumors cause problems by?

A

Location and impingement on adjacent structures
Functional activity such as hormone production
Bleeding and Infection
Symptoms from tumor rupture or infection
Cachexia

125
Q

What are effects of locally located tumors?

A

Intracranial tumors can expand and destroy things around them like the pituitary

GI tract tumors may cause obstruction of the bowel or ulcerate

126
Q

What effect does hormone production of tumors have?

A

causes pareneoplastic syndrome such as hypoglycemia or hypercalcemia

127
Q

What is cancer cachexia?

A

weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current body weight and height

profound loss of muscle mass and fat

128
Q

What are the stages of cancer Cachexia?

A

Precachexia
Cachexia
Refractory Cachexia

129
Q

What causes Cancer Cachexia?

A

multifactorial causes but NOT caloric intake

130
Q

What is the pathophysiology of cancer cachexia?

A

underlying chronic inflammation causing a hypermetabolic state

131
Q

What is a widely accepted cytokine associated with cancer cachexia?

A

TNF alpha

132
Q

What is associated with cancer cachexia?

A

lipolysis and lipid mobilizing factor

133
Q

What is paraneoplastic Syndrome?

A

tumor associated syndromes where the symptoms are not directly related to the spread of the tumor

The earliest clinical manifestations of a neoplasm and can mimic distant spread

134
Q

What are the 4 tumor associated syndromes that the patients can develop?

A

Endocrinopathies
Paraneoplastic Neurologic Syndromes
Thrombotic Diatheses
Hypercalcemia

135
Q

What are paraneoplastic endocrinopathies?

A

non-endocrine cancers that produce hormones or hormone like factors

136
Q

Small cell lung cancer causes what disease by releasing ACTH?

A

Cushings

137
Q

What percentage of patients with Cushing syndrome have lung carcinomas?

A

50%

138
Q

What is the most common paraneoplastic syndrome?

A

Hypercalcemia

139
Q

What tumors are associated with paraneoplastic hypercalcemia?

A

Breast
Lung
Kidney
Ovary

140
Q

What are paraneoplastic neurologic syndromes?

A

heterogenous group of disorders caused by mechanisms other than metastases, metabolic, and nutritional deficits, infections, coagulopathy, or side effects of cancer treatment

141
Q

What is the pathogenesis of paraneoplastic neurologic syndromes?

A

there are antibodies in the serum or CSF of the cancer patients

142
Q

What two types of antibodies are found in paraneoplastic neurologic syndromes?

A

Antibodies directed against intracellular neuronal proteins

Antibodies directed against neuronal cell surface or synaptic proteins

143
Q

What are antibodies directed against intracellular neuronal proteins?

A

well characterized and have association with cancer in the body

Hu/ANNA-1
Ri/ANNA-2

144
Q

What are antibodies directed against neuronal cell surface or synaptic proteins?

A

aren’t always associated with cancer

NMDA receptor

145
Q

What is paraneoplastic thrombotic diatheses?

A

a vicious cycle between activation of the platelet and tumor growth that feed off of eachother

146
Q

What is the pathogenesis of paraneoplastic thrombotic diatheses?

A

1) Tumor stimulates TPO
2) platelet production is increased
3) activated platelets form a shield around the tumor cells
4) platelets also increase metastasis by stimulating angiogenesis

147
Q

What is tumor grading?

A

degree of differentiation

Higher grade are more aggressive than lower grade

148
Q

What is tumor staging?

A

Size and spread of primary tumor

149
Q

What are low grade tumors?

A

Well differentiated

150
Q

What are high grade tumors?

A

undifferentiated

151
Q

What system is used for staging?

A

TNM system

152
Q

What does the T stand for in staging?

A

primary tumor (T1-4)

153
Q

What does the N stand for in staging?

A

regional lymph node involvement (N1-4)

154
Q

What does the M stand for in staging?

A

metastases (M0, M1)

155
Q

What methods do we have for laboratory diagnosis of cancer?

A 
Histologic and Cytological methods
Fine needle aspiration
Flow cytometry
Immunohistochemistry
Circulating tumor cells
156
Q

What ways can laboratory evaluation of a lesion be done?

A

Excision or biopsy
Fine Needle Aspiration
Cytologic Smears

157
Q

What is the most important method of diagnosis?

A

Histologic examination

158
Q

What must be confirmed by a biopsy?

A

Cytologic diagnosis

159
Q

What is fine needle aspiration (FNA)?

A

involves apsiration of cells and fluids from tumor or masses taht are palpable

160
Q

Where can FNA be performed?

A

breast
thyroid
lymph nodes

161
Q

What is cytologic smears?

A

involve examination of exfoliated cells like in PAP smears

162
Q

What is flow cytometry?

A

measures the presence of membrane antigens or DNA content of tumor cells

163
Q

What cancers use flow cytometry?

A

Leukemia

Lymphoma

164
Q

What is immunohistochemistry?

A

detects cell products or surface markers using specific antibodies

165
Q

What is imunohistochemistry used for?

A

Diagnosis of undifferentiated tumors

Determination of site of origin of metastases

Detection of molecules with prognostic or therapeutic significance

166
Q

What are circulating tumor cells?

A

are a subpopulation of tumors cells originated from the primary cancer

They assist in monitoring and predicting cancer progression and evaluating treatment

167
Q

What do circulating tumor cells have the ability to do?

A

disseminate and proliferate as a metastatic lesion

Patho II (16 decks)

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